453.A 45-year-old man lacerated his right forehead after an altercation in
a local bar. Instead of seeking medical attention, the patient applied super
glue to his wound. He successfully stopped the bleeding, but some of the
glue got into his right eye and now he comes to the ED with difficulty open-
ing his right eye. What is the most appropriate treatment of this patient?
a. Call ophthalmology immediately.
b. Wash eye with acetone.
c. Wash eye with normal saline.
d. Use forceps to remove all the glue from the eye.
e. Apply erythromycin ointment.
454.The local sorority house recently installed a sun-tanning station. Two
days later three sorority girls present to the ED with bilateral eye pain, tearing,
and photophobia. After ophthalmic anesthesia instillation, a complete eye
examination is performed. Visual acuity is normal. Extraocular eye movements
are intact and pupils are equal, round, and reactive to light. IOP is normal. Slit-
lamp examination is normal, but fluorescein examination under cobalt blue
light illuminates small dots throughout the cornea. What is the most likely
diagnosis?
a. Ultraviolet keratitis
b. Anterior uveitis
c. Herpes simplex keratitis
d. Allergic conjunctivitis
e. Corneal ulcer
455.A 12-year-old girl presents to the ED for left eye pain and swelling for
2 days. The patient has had cough, congestion, and rhinorrhea for the last
week that is improving. On examination, her temperature is 100.8°F, H R
115 beats per minute, RR 12 breaths per minute, and BP 110/70 mm Hg. On
eye examination, there is purple-red swelling of both upper and lower eye-
lids with injection of the conjunctiva. Pupils are equal and reactive to light.
There is restricted lateral gaze. Visual acuity is 20/70 in the left eye and
20/25 in the right eye. The rest of the physical examination is normal.
What is the most appropriate next step in management?
a. Administer diphenhydramine
b. Administer amoxicillin/clavulanate
c. Administer vancomycin IV
d. Computed tomographic (CT) scan of orbits and sinuses
e. Administer artificial tears
494 Emergency Medicine